Welcome to the Website of
Dr. Michael Zapf, DPM, MPH, FACFAS
Call: (818) 707-3668
Thank you for visiting my website. I have been placing information and articles on this site for many years and have received millions of hits during that time (and not that many of them were mine). I have designed it for people who like to read about their foot and ankle problems. Since I started the web site, I have added two associates to my practice, Dr. Darren Payne and Dr. Stephen Benson. Since my site is filled with just my thoughts and opinions they are not, necessarily, shared by my colleagues. To see our less controversial (and less windy) practice web site, I offer you: www.ConejoFeet.com, the practice site for The Agoura Los Robles Podiatry Centers (ALRPC). The ALRPC practice site has a lot of material about our office, many of our policies and the registration forms to be filled out before your visit. I suggest all prospective patients visit www.ConejoFeet.com.
I made the web site to give my patients the extra depth information that I don’t always have time to cover in the office visit. Visitors who are not my patients are welcome to browse the information found here. I am from a generation that likes to read and read in depth about all sorts of things, including our ailments. This site is dedicated to all those who want more information that what can be contained in a series of bullet points. If you like this philosophy then let me know when you see me or if you ask a question.
Remember, this site is in no way intended to tell you how your own ailment or problem should be treated, only the approach I use when confronted with certain situations. Your problem may well be different from what you think it is and should always be evaluated by the appropriate professional, whether podiatrist, orthopedist or other authority. Please understand that I, nor anyone else, can offer you a proper diagnosis or treatment plan without seeing and feeling the problem at hand (foot?). Happy reading.
Sincerely, Michael Zapf, DPM, MPH, FACFAS, FACFAOM
P.S. All the information in this web site is © by me and it is mine alone. No picture or any of the articles cannot be used by anyone without permission from me, personally.
P.P.S. Comments about this web site or questions about your feet can be directed to me at zfootdoc (at) doctor (dot) com.
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WARTS - Get ready to learn more than you probably ever wanted to know about warts. This page discusses warts in general and the Long-Slow-Painless method of getting rid of them. I also have some great pictures of a surgical excision of a wart belonging to Kristi.
To see Kristi's surgical wart removal please go to -->
This is a photograph of the bottom of Anna's foot. Anna is a most delightful 12 year old girl who has noticed these things develop on the bottom of her foot for the last 6 months. She is an avid basketball player and they are starting to hurt.
Anna has one wart in the middle of her foot (on the left side of the picture) and a cluster of a dozen more down by her heel. All, especially the one in the middle, cause a hot, burning pain when she walks, runs and plays basketball.
Warts are caused by an infectious virus. The little virus gets into the skin through a cut so small you do not know it is there. The virus particle gets into the deepest layer of the dermis and takes up residence in the local cells. It works like all virus particles by getting into the cell and tricking the cell into manufacturing hundreds or thousands of additional virus particles. The cell ruptures spewing the virus particles into the neighboring cells. These cells pick up the wart and repeat the cycle. Soon you have so many cells with virus particles that the clump is visible as a wart.
Q. Why is this wart called a plantar wart?
A. Because the bottom of the foot is known as the plantar surface and a wart there is thereby called a plantar wart. A callus there is called a plantar callus. (A fascia there is called a plantar fascia.)
Q, What is a "Kissing Wart"?
A. Warts can spread directly from one part of the skin to anther if they rub together. For example a wart on the big toe can spread to the 2nd toe just by touching it. You end up with warts on each toe that are kind of mirror images of each other. I have called them kissing warts for obvious reasons. This is an example of a pair of kissing warts.
Direct transmission is one reason why I suggest that you not pick at your warts with your fingers. Warts can spread to your finger and from you finger to where ever you put it.
Q. How do warts spread
A. As Anna walks around she is leaving little piles of wart virus particles. She or her neighbors or family members can step on these evil little particles and spread a wart. If Anna insists on walking around the gym locker room barefooted with her warts, I have asked her to always carry a supply of my business cards with her. She is sure to spread them. I suspect that the wart up by Anna's toes came from this indirect method.
Another way they spread is from cell to cell. In cellular terms it is called pinocytosis (now how often do I get to use that term?) The virus is thought to move from cell to cell for three diameters of the wart. All of the warts clustered by Anna's heel are spread this way.
Q. What do you call a wart that is distressed that you are going to get rid of it?
A. A worry wart! (Sorry)
Q. Why treat a wart?
A. warts are treated for three reasons: 1) they can hurt (just ask Anna) 2) they can spread (again, ask Anna) and 3) if they stay in the skin long enough they can hurt the deep layer of the skin causing a permanent scar.
Q. So what, you may ask, do I care about a scar on the bottom of my foot since no one will see it..
A. Because walking on a scar can hurt every bit as much as the wart itself.
Q. What happens if you do not treat a wart?
A. One of three things may happen: It could stay the same for years, it could get larger or spread to other parts of your (or other's) feet or it could go away. Left alone many warts will go away by themselves given enough time. This may be a long time. however, and, like Anna, you may not want to wait.
Q. How do you treat warts.
A. There are many ways to treat a wart. There is an old saying in medicine; If there are many ways to treat something then none of them must be any good (or, implied, then if one were really good, there would be only one way). I divide my favorite ways of wart treatment into 1) Cut It Out Now 2) The Long Slow Way and 3) Bleomyicn injections (see )
Cut It Out Now
To see great pictures of this method go to -->
This method Involves a nerve block with local anesthesia and using gentle instruments to pry the little sucker right out of the foot. This leaves a little hole where each wart used to be that extends down to (but not through) the bottom layer of the skin. This hole (or these little holes) fill in with new epithelial cells over the next week or two and all is well again. There is only a little pain with the anesthetic block (and I use the Five Famous Tricks to make it hurt as little as humanly possible) and no pain with the procedure itself. Anna wanted this method because she is sick and tired of her warts. I persuaded her (and her delightful mom) that this would leave just too many little holes in her foot and would get in the way of her basketball for several weeks. The advantage of this method is that afterwards it is possible for Anna to leave the office with no warts in her foot at all. About 15% of the time one or more of the little guys come back requiring more treatment. The disadvantage is the pain (though minimal in experienced ad gentle, gentle, gentle hands) and the need to put some kind of medicine on the little holes for a week or so.
The Long Slow Way This is the method I recommended for Anna. It is the gentle method that allows the warts to be treated until they are gone with absolutely no pain at all. Involved are the following
1) Daily or nightly the part of the foot containing the warts is soaked in HOT WATER for 15 minutes. The water needs to be between 105-109 degrees Fahrenheit. Warts have developed in us as human hosts for thousands of years. They like 98.6 degrees. If you heat them up a little they will die. Sometimes. But often enough that it is worth a try. This is an old Farmer's Almanac remedy.
2) Apply a drop of over-the-counter wart acid to each and every. Let it dry. Apply a second drop to each wart. As far as I am concerned all of these acid containing products are roughly equivalent. If you come to my office I will write you a prescription for one in the off chance that your insurance will help you pay for it.
3) Take a high dose of Vitamin A for a month or two. Now this is not a super huge dose. Many drug store vitamins have 10,000 units in a pill form. I suggest you take 20,000 units a day for two months. I have heard from the grape vine that that typical Vitamin A is in the pro-vitamin A form, the gel capsule. You body converts only as much of this product to the Vitamin A it thinks it needs, which is very little. You need actual Vitamin A which is not readily available. A good source of this Vitamin A is mixed with a little Zinc and is from Amway (this is not a solicitation - I am not an Amway distributor).
4) Weekly debridement. Debridement is medical speak for trimming or scraping the lesion) This means you need to visit your podiatrist every week and have him or her scrape a the wart with a scalpel blade until he or she sees very tiny little spots of pinpoint bleeding. Pinpoint bleeding is the end point of debridement.
Follow this plan and you will see the wart's get smaller and thinner weekly until they are gone. This may take from four weeks to a lot longer.
These are pictures of Anna's warts after just one week of the long slow method. For Anna it was not long and slow it was Very Fast. I have never seen a wart resolve this fast before in my 15 years of practice. Do not expect to be this lucky. I just wanted to show you that it is possible.
The picture on the left shows the foot just a week after surgery. The one in the middle is a close up of the lesions that are resolving. Notice how black some of them look. The black is perfect! It means the lesions are dying. The black results from the death of the little blood vessels that feed the wart. The right picture shows a close up of the very same black lesions after I cleaned them out a little. Note that these little suckers are gone.
Q. What about freezing with liquid nitrogen?
A. Freezing the warts with liquid nitrogen is the mainstay of treatment by family practitioners and some dermatologist. It is fabulous for warts on thin skin like the top of the foot, the body surface and even the top of the hands. Unfortunately the skin on the bottom of the foot is so thick that it is difficult to get sufficient freezing of the wart without painful damage to the surrounding skin. While most podiatrists feel this method is not very helpful for plantar warts we do see, after all, only those where the freezing failed. If it did work, then these patients would never have a need for our office.
A Patient Asks About Cimetidine (Tagamet)
Q. I have had some warts surgically removed from my feet and now I have to go back to have them removed again. One of the warts by the time I went in had approximately doubled the size of my pinky toe. It was an extremely painful healing process. That particular wart is the one that is back, and it is accompanied by three on my hands and two more (much smaller ones) on my feet. My doctor suggested taking 400mg of Tagamet (yes, the stomach medicine) three times a day for one month. He said sometimes people have found the medicine sensitizes your body to virus and causes the body to fight it more effectively. I am concerned with taking medicine because my husband and I would like to have children in the next year, but I saw your web site and thought I would ask if you had heard of that or your thoughts on that. Your web site is AWESOME by the way! I appreciate your time and knowledge.
Sorry I did
not mention Cimetidine (Tagamet). There have bee
Another testimonial about Tagamet
Here is a comment from a reader from Missouri about using Tagaqmet.
I read your website and though my warts didn’t spread to my feet, I had a horrible time of them on my hands. This has been going on for about 6 months. I did a 4 month round of having them frozen off. Once every month and every month I had more. A friend suggested the Tagamet. I figured, “what do I have to lose?”. So I did that for about 2 months and they’re all gone. I managed to get rid of all 80 of the, at last count. I would recommend the Tagamet to anyone. The Wal-Mart, Equate brand, works as well.
Q. What is I have more questions?
A. Ask me with an e-mail and I will post them to this site.
Send mail to (zfootdoc at doctor
dot com) with questions or comments about this web site.